Medicaid Fraud Auditor

Peraton; États-Unis; À distance; USD 60 000 - 90 000; Plein temps

Résumé du poste

SafeGuard Services (SGS), a subsidiary of Peraton, is seeking a Medicaid Fraud Auditor to join the SGS team. The role focuses on researching laws, conducting compliance audits across Medicaid cases, and identifying improper payments.

Telework is available from any state in the US, with duties performed independently and in team settings to ensure timely, high-quality work. The position requires 2 years with a BS/BA or 6 years with a HS diploma, strong analytical skills, and proficiency in Excel

Qualifications

• 2 years with BS/BA or 6 years with a HS diploma.
• Experience in accounting or closely related business field, law enforcement, health science or related field.
• Knowledge of internal audit/investigative policies and operating principles.
• Understanding of Medicare/Medicaid or healthcare auditing.
• Strong research and analytical skills.
• Proficiency with Microsoft Office tools, including intermediate to advanced Excel.
• Must be a US Citizen.

Responsabilités

• Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects.
• Conducts compliance audits of varied Medicaid case-types, audits claim submissions and performs ad-hoc focused audits.
• Handle several assignments concurrently; organizes and analyzes billing patterns; conducts interviews and obtains statements from beneficiaries/recipients and others.
• Develops an understanding of the function to be audited and uses business knowledge, analytical skills, and experience in identifying findings and making recommendations for improvements.
• Identifies compliance exceptions, conflicts of interest, improper payments.
• Organizes a case file, accurately and thoroughly documents all steps taken.
• Works independently or as part of a team, provides ongoing progress reports and updates on audit status.
• Presents issues of concern, verified through data, citing regulatory violations, proving schemes or scams to defraud the Government.
• Compose correspondence, reports, and referral summary letters.
• Works under general supervision and as a member of a team delivering high-quality work.
• Ensures that projects are timely, complete and accurate.
• Actively participates at meetings and attends training to further his business acumen.
• Telework is available from any state in the US.

Connaissances

Data analysis

Research skills

Excel

MS Office

US Citizenship

Formation

BS/BA degree

High School diploma

Description du poste

SafeGuard Services (SGS) a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

We are looking to add a Medicaid Fraud Auditor to our SGS team of talented professionals.

Required Qualifications:

• 2 years with BS/BA or 6 years with a HS diploma.
• Experience in accounting or closely related business field, law enforcement, health science or related field.
• Knowledge of internal audit/investigative policies and operating principles.
• Understanding of Medicare/Medicaid or healthcare auditing.
• Strong Research and analytical skills.
• Strong familiarity with Microsoft Office tools, including intermediate to advanced knowledge of Excel.
• Must be a US Citizen

Desirable Qualifications

• Intermediate financial and business acumen.
• Intermediate audit/investigative skills
• Project management skills.
• Knowledge of the healthcare industry and medical coding concepts and/or experience analyzing health care claims data is preferred

What you'll do:

• Provides research, interprets laws and regulations, performs data analysis and draws conclusions for projects;
• Conducts compliance audits of varied Medicaid case-types, audits claim submissions and performs ad-hoc focused audits;
• Handle several assignments concurrently; organizes and analyzes billing patterns; conducts interviews and obtains statements from beneficiaries/recipients and others;
• Develops an understanding of the function to be audited and uses business knowledge, analytical skills, and experience in identifying findings and making recommendations for improvements Identifies compliance exceptions, conflicts of interest, improper payments.
• Organizes a case file, accurately and thoroughly documents all steps taken;
• Works independently or at times as part of a team, provides ongoing progress reports and updates on audit status;
• Presents issues of concern, verified through data, citing regulatory violations, proving schemes or scams to defraud the Government;
• Compose correspondence, reports, and referral summary letters;
• Works under general supervision and as a member of a team delivering high-quality work;
• Ensures that projects are timely, complete and accurate.
• Actively participants at meetings and attends training to further his business acumen.
• Telework is available from any state in the US.